CONFIDENTIAL

APSC EMPLOYEE SELF EVALUATION FORM

Name: Date:

Position: Employment Date:

This self-evaluation will be of help to both you and APSC in reviewing your progress and in future planning. It
provides an opportunity to compare your view with that of your employer’s on your performance. After
completing the evaluation questions (use additional paper if needed), please submit to your Office Manager.
This form will be discussed when your performance evaluation takes place. Please remember confidentiality
and do not discuss any part of your evaluation with others.

1. List major duties and responsibilities of your job.

2. Describe your accomplishments during this assessment period. Are there areas in
which you feel you have excelled (e.g., time management, organization skills)? In what
area would you like to improve?

3. If there were satisfactions or dissatisfactions with your position this year, what in your
opinion were the causes?

4800 Whitesport Circle, Ste 2 – Huntsville, AL 35801 – (256) 533-9393 – Fax (256) 533-9690
100 Essex Court, Ste A – Madison, AL 35758 – (256) 325-2388 – Fax (256)325-2395
apsc@alapsych.com
 CONFIDENTIAL

4. What could your office manager and/or APSC do differently to help you better perform
your job?

5. Is there any training or experience you feel would be helpful in enhancing your abilities
relative to your position?

6. What are your goals for the next year and what action will you take to accomplish
these goals?

7. Are there any other specific issues or goals you wish to discuss?

__________________________________________ _________________________
Employee Signature Date

4800 Whitesport Circle, Ste 2 – Huntsville, AL 35801 – (256) 533-9393 – Fax (256) 533-9690
100 Essex Court, Ste A – Madison, AL 35758 – (256) 325-2388 – Fax (256)325-2395
apsc@alapsych.com